CONFIDENTIAL
QUANTUM LEAP INITIATIVE
Application Form
This form must be filled in with “Arial 11” font, typed at 1.15 line spacing
Duration of the Project
Total Amount of the Project
Amount Requested from CQDM
TITLE OF THE PROJECT (English)
For internal use
File # :
TITLE OF THE PROJECT (French)
DELIVERABLES
The deliverables are the concrete, tangible work products resulting from the completion of the project and they are not to be confused with milestones that indicate important steps toward completion of the project.
Define the tangible assets that will result from your work and its intended use in the drug R&D process. Explain how and in what form the deliverables may be transferable to the industry for their use in biopharmaceutical research.
IDENTIFICATION OF THE PRINCIPAL INVESTIGATOR (PI)
First name: Last Name:
Private organisation or
University/Department
Address:
City:
Country:
Province:
Phone #:
Postal Code:
Ext:
Email:
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SECTION 1. IDENTIFICATION OF THE RESEARCH GROUP (PIs and CO-INVESTIGATORS; including those from private organizations) Add lines if necessary
Numeration
(to be used in section 5)
Name Affiliation Email
Contribution to the project
Private sector (P) or Academia (A)
% of the budget allocated to this group
1
PI
2
3
4
5
6
7
8
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SECTION 2. PROJECT SUMMARY (maximum 1 page)
Define the following aspects of your project: background information, current state of the technology, objectives, experimental approach and brief research plan.
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SECTION 3. DESCRIPTION OF THE PROJECT (maximum 5 pages, including figures and tables; please include references in Appendix)
Describe the project by outlining the following aspects:

Rationale and Preliminary Results:
Describe the existing platform and how it is already addressing an important gap in drug research and development.

Research Plan:
Describe how you will improve the platform; include the expected results, milestones, deliverables and go/no go decision points.
NOTE:

The Quantum Leap initiative is designed to be an interactive application process.

As such, successful applicants may have to present their project in front of CQDM review committee as well as provide new information in writing to clarify their proposal.
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SECTION 4. ROLE OF THE ORGANIZATION AND DESCRIPTION OF THE RESEARCH TEAM (maximum 2 pages)
1) Provide a global overview of the organization (SME or academic research group):

Discuss how the proposed project is aligned with its overall corporate objectives;

Describe how the organization is qualified to successfully complete the project;
2) Discuss the role of the PIs and co-investigators (listed in section 1) in the successful achievement of the project.
3) Describe their experience and expertise relevant to the proposed project, emphasizing on how they are essential to the project.
4) Discuss the synergies and complementarities of the team members.
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SECTION 5. QUANTUM LEAP JUSTIFICATION: Impact of the improved platform on drug research and development process (maximum 2 pages)
What gap in the pharmaceutical research and development process is the project trying to resolve?
Describe how the technology is aligned with pharma needs and how it will improve, enhance or accelerate the drug R&D process
If applicable, describe the impacts on : o Opening new therapeutic approaches and research avenues; o Bringing more effective medicines to the clinic and to the market; o Increasing the efficacy of existing drugs; o Reducing R&D costs, time to market or decreasing the risks of development; o Other impacts on the drug discovery and development process.
Describe the novelty and the originality of the technical approach and explain how the proposed research represents a major breakthrough (a quantum leap step) with respect to existing (or in development) technologies worldwide.
Describe the added value of the technology with regard to future potential applications and the international competing technologies used to achieve similar readout or goals.
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SECTION 6. TIMELINES OF THE RESEARCH PROJECT (Gantt chart; maximum 1 page)
1) Insert a Gantt chart illustrating the principal steps of the project as well as milestones, deliverables and go/no go decision points (as described under section 3).
2) Identify in the Gantt chart the specific contribution of each PI and co-investigator* at the different steps of the project and specify the cost of each step.
*by referring to the numbers associated with the investigators as listed in Section 1.
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SECTION 7. COMMERCIALISATION OPPORTUNITIES AND BUSINESS PLAN (maximum 1 page)
Outline the opportunities your technology will create in the biopharma R&D sector. Describe the potential commercial value of your technology and the technical development plan that would be required to commercialise the technology
(manufacturing, scale-up, regulation, foreground and background IP, etc.), including a brief tentative timeline. If applicable, briefly discuss your business plan, such as how will funding of this project will create synergistic value for your organization and how is the project aligned with corporate goals.
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SECTION 8. PRELIMINARY BUDGET *
ESTIMATED COSTS OF
PROJECT
Year 1
(in thousands $)
Year 2
(in thousands $)
Year 3
(in thousands $)
TOTAL
(in thousands $)
Salaries and benefits
(research staff, payment to students)
Material and supplies
Travel expenses
(conferences, seminars, symposia fieldwork)
Publication and dissemination costs
CQDM Private CQDM Private CQDM Private CQDM Private
Consulting and subcontracting services
Other (please specify)
Intellectual property costs
(patent application and maintenance fees);
TOTAL PER YEAR
Please indicate if there are other sources of funding for this project.
*Please note that a detailed budget will be required for applications that CQDM is seriously considering for funding.
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SECTION 9. INTELLECTUAL PROPERTY
9.1 IS THERE ANY PRE-EXISTING INTELLECTUAL PROPERTY (IP) LINKED TO YOUR PROJECT?
Yes
If yes, please answer the following questions (maximum 1 page):
No
1. Is the background IP absolutely necessary to use the proposed technology?
2. Is the project an improvement of the existing technology or a new technology altogether?
3. Who are the IP owners?
4. What is the invention?
5. Who holds the rights to the IP?
6. Do the principal investigator and the co-investigators of this project have the legal authorization to use the pre-existing IP?
7. Are there any commercial relationships or agreements (e.g. licensing agreements) with regards to the preexisting IP? If so, please describe.
9.2 WILL YOUR PROJECT GENERATE NEW INTELLECTUAL PROPERTY (IP)?
If yes, please describe (maximum 1 page):
1) The technology that will result in the creation of the new IP.
2) Who will be the inventor(s)?
Yes No
3) Who will hold the IP rights? Is that person/organization aware of the CQDM licensing policy (described in the call for proposals)?
4) Describe the overall strategy regarding data and IP sharing.
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SECTION 10. SIGNATURE OF PI AND ALL CO-INVESTIGATORS (add pages, if necessary)
Please note that this form must be signed by the PI and every co-investigators
1.
I authorize CQDM to exchange all information relating to this application for analysis or evaluation purposes, provided that all persons granted access to this information treat it in the strictest confidence.
2.
I understand that the intellectual property resulting from this project will belong to the inventor(s) and their institutions and that a non-exclusive end-user license option will be granted to the CQDM industrial sponsors. The terms of said license option will be negotiated before the beginning of the project no later than 3 months following the confirmation of the funding.
3.
I agree that, if this project is retained for funding, I will facilitate the signing of an agreement with respect to the funding and the option on the IP generated by this project.
4.
I certify that all information provided in this application is complete and accurate to the best of my knowledge.
Signature of the authorized organization representative
(PI):
Name:
Date:
Signature of the co-investigator:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
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